Key result
Distal trans-radial access demonstrated a comparable procedural success rate to conventional access (96% vs. 98%, p=0.38) while significantly reducing radial artery occlusion from 13% to 2%.
Why the study?
Distal radial artery puncture may reduce the incidence of radial artery occlusion compared with conventional wrist puncture, but its feasibility for coronary angiography needed evaluation.
Does distal trans-radial access reduce radial artery occlusion and improve procedural outcomes compared to conventional trans-radial access in patients undergoing coronary angiography?
RCT (n=420)
Single-blind
Randomized
No
Does distal trans-radial access reduce radial artery occlusion and improve procedural outcomes compared to conventional trans-radial access in patients undergoing coronary angiography?
Distal trans-radial access is a safe and feasible alternative to conventional trans-radial access for coronary angiography, significantly reducing the risk of radial artery occlusion despite a lower first-attempt puncture success rate.
Answers are grounded in this paper and cite their sources.
Supports distal over conventional trans-radial access to reduce occlusion risk; confirms randomized benefit with preserved success in coronary angiography.
Background Compared with a conventional wrist puncture for radial artery catheterization, a distal radial artery puncture has the advantage of reducing the incidence of radial artery occlusion (RAO). Aim The present study was designed to evaluate the feasibility of distal trans-radial access compared with conventional trans-radial access for coronary angiography. Methods A prospective, randomized, single-blinded, comparative study was conducted at a tertiary care center in India between December 2018 and November 2020. A total of 420 patients (aged >18 years) with signs and symptoms suggestive of coronary artery disease (CAD) and with a palpable radial artery in anatomical snuffbox were randomized into two groups. Group A comprised patients accessed at the distal trans-radial site, and Group B consisted of patients accessed at the conventional trans-radial site for coronary angiography. Baseline demographics, clinical history, and risk factors for CAD were documented. Procedural-related parameters and complications were compared between the two groups. Results The procedural success rate was non-significant between Group A and Group B (96% vs. 98%; p=0.38). Puncture in a single attempt was higher in Group B compared to Group A (92% vs. 78%; p<0.001). There was no significant difference between Group A and Group B for operation time (p=0.207), fluoroscopy time (p=0.183), and contrast volume (p=0.345). The rate of RAO was higher in Group B compared to Group A (13% vs. 2%; p<0.001). Radial artery hematoma/swelling at the puncture site between Group A (10%) and Group B (8%) was not significant (p=0.61). Post-procedural hemostasis time in Group A was 28 ± 7.86 minutes, and in Group B was 24 ± 6.23 minutes. Both post-procedural persistence of pain (p<0.001) and hand clumsiness (p<0.001) were significantly higher in Group B compared to Group A. Conclusion For coronary angiography, the distal trans-radial access site is a reliable and secure alternate access site.
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Gupta et al. (2023) conducted an RCT in Coronary artery disease (n=420). Distal trans-radial access vs. Conventional trans-radial access was evaluated on Procedural success rate (p=0.38). Distal trans-radial access demonstrated a comparable procedural success rate to conventional access (96% vs. 98%, p=0.38) while significantly reducing radial artery occlusion from 13% to 2%.
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